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Vaccine Hesitancy Practice Improvement Project

Please take the Vaccine Hesitancy Pretest and review the Case Studies before beginning a practice improvement project. They will give you information about vaccine-hesitant parents and strategies to communicate with them. After viewing the Case Studies, consider if there is anything that you would change in your practice about communicating with hesitant parents. Below is a sample practice project. As you implement your project, we invite you to share and learn from other practices in the Discussion Board.

Background information on vaccine hesitancy:
Despite vaccines' success, and perhaps because of it, some parents have concerns about the necessity and safety of vaccines and are reluctant to have their children vaccinated. Pediatricians report that parental vaccine hesitancy is one of the most common barriers to vaccinating. It has been reported that nearly all pediatricians encounter parents who delay or refuse vaccines in an average month. Despite research on different models and methods to address hesitancy, there are no magic messages or approaches that work with all parents. However, a strong recommendation from a pediatrician and accessible body language have been found to increase the likelihood of vaccination.

For this module, one practice project could be testing the effectiveness of an approach or style with specific types of hesitant parents.

Clinical question:
How many parents who ask questions about vaccines opt to follow your recommendation that day? For each vaccine recommended, how many are accepted, delayed, or refused?

Assess to determine if there is a problem (establish a baseline):
Choose a baseline period (consider spending at least 2 weeks) to continue communicating with parents as you have been, without any change. During the baseline period, record how many parents/families have questions about your vaccine recommendations and how many of those families accept, delay or refuse vaccines. There may be a place for this in the patient's regular chart. If not, consider drafting a simple form (paper or electronic) that can be brought into patient encounters (see example on pages 4 & 5).

Organize a team to address this problem:
If other staff members discuss vaccines with families, be sure they are comfortable supporting your recommendation, style, and messages. A front office staff or nurse who supports your approach to vaccination can reinforce positive messages with parents.

​Develop an AIM statement to address the issue:
As you review the baseline data, note any patterns. For example, are there particular vaccines that are most often questioned, or do families with children of a particular age have more concerns? Consider the possible additions or changes to your discussions:

  • Add a closing statement about vaccinating your own children/grandchildren/nieces or nephews.
  • Talk about the risks or consequences of contracting a specific disease.
  • Take a presumptive vs participatory approach at the beginning of the conversation.
  • Ask where a family heard about their concerns and discuss the credibility of the source.
  • After being asked a question, find common ground by stating that you both want what is best for the child.

A Team AIM statement may be: Over 2 weeks, when a family asks questions about MMR vaccine, the pediatrician will discuss recent outbreaks and risks of measles disease. She will end with a recommendation and statement that she has vaccinated her own child. Specific questions and results (if vaccines were accepted, delayed, or refused) will be recorded.

Note: Your office may choose a longer time period to study if you are not likely to see many children due for MMR vaccine in 2 weeks. It is recommended, however, to keep test periods relatively short and assess progress in case alterations need to be made.

Prepare to record the information on vaccine questions and behaviors. If this information does not fit in patient charts, consider a separate tracking system such as the sample below. Track your baseline data for about 2 weeks. Choose a communication strategy (eg, CASE Model, presumptive recommendation, motivational interviewing, specific messages based on vaccines/disease) or other change (eg, giving a strong recommendation, saying you would recommend vaccination for your child or family member). After the baseline data collection period, begin your chosen change. Be sure that the change has been discussed with staff and any concerns addressed. Implement your intervention for about 2 weeks. Compare rates of vaccine acceptance to the baseline to see if the change is working.

Resources to help include:

Follow up:
If you did not see improvement, consider continuing the intervention for another 2 weeks or choosing a different intervention. If vaccine acceptance rates do improve, consider continuing the vaccine communication strategy. Discuss any unanticipated impact on office procedures and staff.

Suggested measure:
80% (or choose a percentage that is a modest improvement in comparison to your baseline data) of vaccines recommended during patient encounters are accepted and administered during the same encounter. (Alternatively, consider the number of families to accept your recommendation rather than the number of vaccines.)

Numerator: # of vaccines accepted and administered at the time of the recommendation during the period of measurement.

Denominator: # of all vaccines recommended (including those accepted, delayed or refused) during the period of measurement.​

ABC Pediatrics
Vaccine Hesitancy Practice Improvement Data
Baseline Timeframe: 1/1/16-1/28/16

Patient Number Type of Visit Patient Age Vaccine Recommended Questions Asked Vaccine Status


Well-child, 4 months4 monthsDTaPNoAccepted
PCV13 YesDelayed

ABC Pediatrics
Vaccine Hesitancy Practice Improvement Data
Test Period Week 1: 1/29/16-2/12/16
Communication method: Intervention period, CASE Model​

Patient Number Type of Visit Patient Age Vaccine Recommended Questions Asked Vaccine Status



Well-child, 2 months2 monthsDTaPYesAccepted
PCV13 YesDelayed